Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 213E00000X | Podiatrist | | SC001429L | PENNSYLVANIA | No |
| 2 | 213E00000X | Podiatrist | | 25MD00092600 | NEW JERSEY | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | CA000033400 | OTHER | NEW JERSEY | AMERICHOICE OF NJ |
| 2 | 14952 | OTHER | NEW JERSEY | AMERIGROUP |
| 3 | 0090238000 | OTHER | PENNSYLVANIA | PA BLUE SHIELD |
| 4 | P898164 | OTHER | | OXFORD |
| 5 | 4800233093 | OTHER | | RAIL ROAD MEDICARE |
| 6 | 0004916 | OTHER | NEW JERSEY | AETNA |
| 7 | T72489 | MEDICARE UPIN | | |
| 8 | FO110209 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 9 | 155550201 | MEDICAID | NEW JERSEY | |
| 10 | 054016FHA | MEDICARE PIN | PENNSYLVANIA | |
| 11 | F14284 | OTHER | | HEALTH NET |
| 12 | 0070293 | OTHER | | GROUP HEALTH INS. |
| 13 | 0000180805 | MEDICARE NSC | NEW JERSEY | |
| 14 | 16720 | OTHER | | UNIVERSITY HEALTH PLAN |
| 15 | 24074 | OTHER | NEW JERSEY | OPERATING ENGINEERS |
| 16 | 0000054016 | MEDICARE NSC | PENNSYLVANIA | |
| 17 | 1085556 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 18 | 4394780 | OTHER | | AETNA |
| 19 | 180805AL1 | MEDICARE PIN | NEW JERSEY | |